This prospective study of approximately 23,000 male Chinese government employees in Taiwan was begun in 1976 to determine the incidence and relative risk of death from cirrhosis and/or primary hepatocellular carcinoma (PHC) in relation to hepatitis B virus (HBV) markers. Case finding is essentially 100% because all participants have health and life insurance so all deaths in the cohort and their cause are known to us. To date 61 of 62 PHC cases that have occurred have been among the 15% of the cohort who are HBsAg carriers, a relative risk of 340. Excess mortality among HBsAg carriers has been observed for PHC and cirrhosis but not other causes. Annual AFP screening indicates that AFP elevations begin long before the clinical onset and have a long linear rise as the tumor grows. With annual screening small resectable tumors are detectable. It is too early to determine the frequency of resectable tumors nor cure rates among resected tumors, however, three persons are alive and well with normal AFP a year or more after resection. The current principle objective of this study is to obtain more new early PHC cases by AFP screening in order to determine when diagnostic workups and surgical intervention should be undertaken. Once the success rates can be estimated it will be possible to determine whether it should be put into practice.